When my first was born over seven years ago, I had done so much research on breastfeeding. I even went out and bought a Medela Pump In Style Advance, one of the best pumps on the market at the time (well before Tricare covered the cost!). I had piles of breast pads, nipple creams, and breastmilk storage containers. It was clear I was not at all aware of the many challenges nursing parents face. When my son came into the world, and was ready to eat… we tried. It was awkward! It was not the glorious straight-out-of-an-oil-painting image I had imagined so many times. His latch was not so great, and my positioning in the hospital bed was off- wasn’t this supposed to come naturally? I had all of the knowledge and tools I thought I needed, so what gives?
The nurse came around to check on us shortly after his birth, and I expressed my dismay. It was clear my baby was hungry, but why didn’t my breast stay in his mouth? She replied that while she couldn’t be sure by looking at them, she suspected that I may have flat or inverted nipples.
What!? I immediately felt self-conscious. I did not think there was anything wrong with my nipples. They looked totally normal to me. She demonstrated a “pinch test” (not painful), where the areola is compressed between the thumb and forefinger. A truly flat or inverted nipple will not become erect when this is done. Instead, it will “dimple” or retract. Little did I know, having flat nipples did not mean anything was “wrong” with me. In fact, if you suspect you have flat or inverted nipples, it will likely have little to no effect on your breastfeeding journey with a few simple techniques.
- Make sure baby has a good latch. This is vitally important, and something all breastfeeding mothers will hear at one time or another. If the baby has enough of your breast in his or her mouth, it will eliminate nipple pain, increase the flow of milk, and help bring the nipple out more for a “deep latch”. It helps to hold baby very close against your body when feeding, and tickle your baby’s upper lip with your nipple in order for them to open wide for a good latch.
- Breastfeed on demand. Especially those first few weeks after birth. They say that “practice makes perfect” and this is especially true for breastfeeding. After all, it is something completely new for each mom and her baby. Even if you’ve breastfed before, it’s a new experience with each child. Once you’ve learned the most comfortable position, and best latch technique for you and baby: practice, practice, practice!
- Stimulate your nipples before each feeding. Roll your nipple between your thumb and forefinger for a minute or so before attempting to latch your baby. This will help encourage the aforementioned deep latch that is ideal.
- The asymmetric latch technique is also helpful in order to get more of your breast (and therefore nipple) into baby’s mouth. Here is an article by Dr. Jack Newman that explains the technique more thoroughly. Basically, it ensures the baby’s chin is in the breast, while the nose is not, and the baby will cover more of your areola with their lower lip. This helps draw the nipple out and up toward the roof of the baby’s mouth.
- The Hoffman Technique is an exercise that may help stretch the area of the nipple that is causing it to be flat or inverted. Try it by placing both thumbs on either side of the base of your nipple, and gently pull the thumbs away from each other, and in different directions, as explained in this article by IBCLC Anne Smith.
If you have tried these techniques, and you are experiencing difficulty and pain, and/or your baby is not having an adequate amount of dirty or wet diapers, please consult your baby’s pediatrician immediately. Having great lactation support on board is also helpful, which is why Stars and Stripes Doulas are able to direct the families we support to tried and true lactation consultants.
Written by: Justine Robinson, Stars and Stripes Doulas of Washington DC